Understanding Insurance Covered Weight Loss Programs & How to Qualify

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Lauren Lewthwaite 20-10-2021

Does My Health Insurance Cover Weight Loss Surgery?

insurance covered weight loss programs

Weight loss covered by insurance is an important topic, now more than ever. With over 40% of adults in America considered obsese, finding weight loss procedures covered by insurance can be life changing. The good news is that insurance providers do want you to be healthier, because the cost of healthcare coverage for those that are obsese is higher than those at a healthy weight. 

Keep reading to find out the answer to, “does insurance cover weight loss programs?” once and for all. 

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Is Weight Loss Covered By Insurance?

This is a common question, thanks to the rising rates of obesity in North America. But the answer isn’t quite so simple. It varies by insurance provider, and even if covered, the requirements to qualify can be stringent. 

Some of the requirements for weight loss procedures covered by insurance, such as bariatric surgery, include:

  • Being at least 18 years of age
  • Being diagnosed morbidly obese for a certain amount of time before surgery
  • Having a BMI over 40 or over 35 if you also have high blood pressure, type 2 diabetes or other weight-related risk factors 
  • Being able to show proof of weight loss efforts over a specified period of time
  • Completing a weight loss program specified by your insurance provider
  • Quitting smoking
  • No substance abuse
  • Psychological testing
  • Classes to help with the surgery and life after it

These are just some of the typical requirements to have bariatric surgery for weight loss covered by insurance. The reasoning is that it’s an incredibly expensive surgery and insurance providers don’t necessarily want the expense without you being able to show it’s absolutely necessary and that you’ve tried other options first. 

It’s important to note that most insurance providers don’t cover commercial weight loss programs. 

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Insurance Covered Weight Loss Programs

You might have to jump through a few hoops before getting approved for insurance covered weight loss programs. In fact, you could get denied three times or more before getting approval. 

It’s a good idea to get pre-approval prior to surgery, because it gives you a better chance of having what you need ahead of time. You’ll want to find out from your insurance provider exactly what’s needed, but it’s likely going to involve a ton of paperwork and your doctor’s involvement. 

Having all your ducks in a row will improve your chances of getting approved on the first try and not have to deal with appeals. Plus, once you have bariatric surgery, it’s hard to fulfill certain requirements like completing a weight loss program or documenting weight loss efforts. 

If you are approved, you’ll want to make sure you know exactly what that entails, such as:

  • Is there a deductible?
  • How much of the surgery and recovery is covered?
  • Is anything not covered?
  • How long does reimbursement take?

Having the answers to these questions will ensure you’re fully prepared for the financial aspect of weight loss surgery and leave nothing to surprise. 

Weight Loss Programs Not Covered By Insurance

If your insurance doesn’t cover weight loss programs or surgery, you still have options. After all, insurance providers do want you to be healthier because it costs them less overall in healthcare costs and makes you a more productive employee. 

If your surgery has been denied, you have a few options available to you:

  • If it’s covered by your provider but you’ve been denied, appeal it. 
  • If it’s not covered by your provider, other providers may offer you coverage and it may be worthwhile to switch plans (or even jobs, for a new healthcare plan). 
  • See if paying out of pocket is an option for you, especially if there are payment plans available. 
  • Try more weight loss steps to either get approved or to lose weight without surgery.

Being denied coverage is not the end of the road. Not only do you have ways to increase your chances of approval, but you also have other options for healthy, sustainable weight loss. 

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Last Thoughts On Insurance Covered Weight Loss Programs

Bariatric surgery is the right option for many, but it’s not the only option. If your insurance provider covers weight loss surgery and programs, it’s often a great, cost effective way to become healthier quickly. But if not, you still have many options available to you to live a healthier, longer life. 

Lauren LewthwaiteLauren Lewthwaite has been freelance writing for almost five years writing content that ranges from health to insurance and everything in between. Lauren is also a trained translator in French and English and is a dog-mom to an adorable Australian Shepherd.